Recent polls show that the 9/11 commission hearings, the bombings in Spain and the worsening situation in Iraq have left Americans ever more jittery about their personal safety. So now might be an excellent time to ask why, more than two years after airplane attacks and anthrax, we seem so ill-prepared to handle an emergency of a similar scale or larger.
If preparation meant spraying money in every possible direction and designing a bunch of nifty PowerPoint presentations, we would be all set. But actually being ready seems to have been overshadowed by the torrent of reports and by plans for flashy gadgetry such as an array of "biosensors" sniffing urban air randomly for potential hazards (I kid you not). The sad reality is that our public health infrastructure could not handle mass casualties from a biological or-heaven forbid-nuclear attack.
The sense of drift is obvious. Just for one example, in his 2003 State of the Union speech, President Bush proposed Project BioShield, a 10-year, $6 billion initiative to develop better vaccines and treatments for threats like anthrax bacteria. The House overwhelmingly approved it almost a year ago, but it has been stalled in the Senate ever since, without explanation.
President Bush's proposed fiscal 2005 budget actually calls for cuts of $105 million in federal funding for state and local bioterrorism preparedness and $116 million in the budget of the federal Centers for Disease Control and Prevention.
Two General Accounting Office studies in the past nine months have found that despite spending more than $3 billion since 2002, states, localities and hospitals aren't ready for a big terror attack. For example, no state reported having a plan for hospitals in the state to respond to an epidemic involving at least 500 patients. Most hospitals still lack the needed equipment and emergency room capacity to triage, track and treat mass casualties, a variety of reports have found. Fewer than half of all hospitals have conducted drills simulating a response to a terror attack.
Julie Gerberding, the head of the CDC, says physicians are "woefully underprepared" to recognize the start of a disease outbreak or release of toxic chemicals.
There is some progress, of course. Five biological-containment laboratories for research and response are being built around the nation, and nine more are on the drawing boards. The Federal Emergency Management Agency is spending $3.4 billion in 2004 and 2005 to stockpile vaccines around the country. There is now enough of the smallpox vaccine to inoculate every American.
In addition, most hospitals reported having provided at least some training to their personnel on identification and diagnosis of diseases caused by biological agents considered likely to be used in a bioterrorist attack, such as anthrax or botulism.
Jerome Hauer, now executive director of the Response to Emergencies and Disasters Institute and until recently acting HHS assistant secretary for public health emergency preparedness, notes that the research and development dollars are there to answer some of the science challenges, but under current planning, "We won't have the infrastructure for treating people or delivering vaccines, and I think that is shortsighted."
A White House office with a staff of 66 people is overseeing the overall $40 billion in homeland-security activities. Senior staffers who have spoken out of school are concerned about how much is being spent for so little a result.
I hope that some of the booty being spread around happens to fall in enough of the right cracks to do some good. Meanwhile, let us pray that the intelligence community can continue to keep the terrorists at bay. We aren't ready for them here.